Provider Demographics
NPI:1336980127
Name:PRASERTTHANABUT, SORAWAN (PHARMD,RPH)
Entity type:Individual
Prefix:
First Name:SORAWAN
Middle Name:
Last Name:PRASERTTHANABUT
Suffix:
Gender:F
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2301
Mailing Address - Country:US
Mailing Address - Phone:559-226-1485
Mailing Address - Fax:
Practice Address - Street 1:728 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2301
Practice Address - Country:US
Practice Address - Phone:559-226-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist